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J Eval Clin Pract. 2017 Oct;23(5):964-970. doi: 10.1111/jep.12752. Epub 2017 May 16.

Has evidence-based medicine ever been modern? A Latour-inspired understanding of a changing EBM.

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Medical Faculty, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Continuing Education/Evidence-based Health Care, University of Oxford, Oxford, UK.
Medical Faculty, Primary Care Health Sciences Oxford, University of Oxford, Oxford, UK.


Evidence-based health care (EBHC), previously evidence-based medicine (EBM), is considered by many to have modernized health care and brought it from an authority-based past to a more rationalist, scientific grounding. But recent concerns and criticisms pose serious challenges and urge us to look at the fundamentals of a changing EBHC. In this paper, we present French philosopher Bruno Latour's vision on modernity as a framework to discuss current changes in the discourse on EBHC/EBM. Drawing on Latour's work, we argue that the early EBM movement had a strong modernist agenda with an aim to "purify" clinical reality into a dichotomy of objective "evidence" from nature and subjective "preferences" from human society and culture. However, we argue that this shift has proved impossible to achieve in reality. Several recent developments appear to point to a demise of purified evidence in the EBHC discourse and a growing recognition-albeit implicit and undertheorized-that evidence in clinical decision making is relentlessly situated and contextual. The unique, individual patient, not abstracted truths from distant research studies, must be the starting point for clinical practice. It follows that the EBHC community needs to reconsider the assumption that science should be abstracted from culture and acknowledge that knowledge from human culture and nature both need translation and interpretation. The implications for clinical reasoning are far reaching. We offer some preliminary principles for conceptualizing EBHC as a "situated practice" rather than as a sequence of research-driven abstract decisions.


epistemology; evidence-based medicine; health care; medical research; philosophy of medicine

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